scholarly journals Characteristics of symptom burden in atrial fibrillation with concomitant heart failure

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ran Heo ◽  
Myung-Jin Cha ◽  
Tae-Hoon Kim ◽  
Jung Myung Lee ◽  
Junbeom Park ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Symptom Control ◽  
Symptom Burden ◽  
Heart Rhythm ◽  
Comparison Study ◽  
Reduced Ejection Fraction ◽  
Atypical Symptoms

Abstract Background Symptom burden is an important factor in determining the treatment of atrial fibrillation (AF). AF is frequently accompanied by heart failure (HF). This study investigated the characteristics of AF symptoms with concomitant HF. Methods A total of 4885 patients with AF were consecutively enrolled through a prospective observational registry (the Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation [CODE-AF] registry). Clinically diagnosed HF was divided into three categories (preserved, mid-range, and reduced ejection fraction [EF]). Symptom severity was assessed using the European Heart Rhythm Association (EHRA) classification. Results The presence of AF-related symptoms was comparable irrespective of concomitant HF. Patients with HF with reduced EF demonstrated severe (EHRA classes 3 and 4) and atypical symptoms. HF with preserved EF was also associated with atypical symptoms. Female sex and AF type were associated with the presence of symptoms in AF without HF, and non-maintenance of sinus rhythm and increased left atrial pressure (E/e′ ≥ 15) were factors related to the presence of symptoms in AF with HF. Conclusion AF with concomitant HF presented with more severe and atypical symptoms than AF without HF. Maintaining the sinus rhythm and reducing the E/e’ ratio are important factors for reducing symptoms in AF with concomitant HF.

Abstract 16642: Distinctive Characteristics of Left Atrial Remodeling in Heart Failure With Preserved or Reduced Ejection Faction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vojtech Melenovsky ◽  
Rosita Zakeri ◽  
Margaret M Redfield ◽  
Barry A Borlaug
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Contractile Function ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Atrial Remodeling ◽  
Reduced Ejection Fraction ◽  
V Wave

Introduction: Left atrial structure and function (LA) is affected by the presence of heart failure (HF), but the specific impact of HF subtype is poorly characterized. Hypothesis: HF-induced LA remodeling differs between patients with preserved (pEF) or reduced ejection fraction (rEF). Methods: 198 consecutive HF patients referred to Mayo Clinic (51% HFpEF, NYHA 3.1±0.7, 66±13 years, 39% females) and 40 HF-free controls of similar age and gender underwent right heart catheterization (LA pressures), echocardiography (LA volumes) and follow-up. Results: Compared with controls, HF patients had larger atria and more impaired LA reservoir and contractile function (total and active LAEF, all p<0.001). At identical mean LA pressure (20 vs 20 mmHg, p=0.9), HFrEF patients had larger LA volumes (LAVI 50 vs 41 ml/m 2 p<0.001), but HFpEF patients had higher LA peak (V-wave) and lower LA minimal pressures, with higher LA stiffness (0.79 vs 0.48 mmHg.ml -1 , p<0.001, Fig-A) and LA pressure pulsatility (19 vs 13 mmHg, p<0.001). Despite smaller LA size, better LA function (total LAEF 39 vs 35 %, p=0.04, active LAEF 30 vs 22 %, p<0.001) and less mitral regurgitation (grade 1.8 vs 2.5, p<0.001), HFpEF patients had more atrial fibrillation (42 vs 26%, p=0.02). After a median follow-up 350 days, 31 HFpEF and 28 HFrEF patients died. LA function was associated with mortality in HFpEF, but not in HFrEF (Fig-B). Conclusions: HFrEF is characterized by greater eccentric LA remodeling, but HFpEF is associated with increased LA stiffening and greater LA pressure pulsatility which may contribute to greater burden of atrial fibrillation. The observation that LA function is more closely linked to outcome in HFpEF supports the goal to maintain or improve LA function in HFpEF.

Abstract TP173: Reduced Ejection Fraction and Left Atrial Dilatation are Independently Associated With Cardioembolic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Maryam Hosseini Farahabadi ◽  
Shadi Milani-Nejad ◽  
Shimeng Liu ◽  
Wengui Yu ◽  
Mohammad Shafie
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Cardioembolic Stroke ◽  
Left Atrial Size ◽  
Reduced Ejection Fraction ◽  
Atrial Size ◽  
Left Atrial Dilatation

Introduction: The role of heart failure and left atrial dilatation as independent risk factors for ischemic stroke has remained controversial. The goal of this study is to evaluate the association between reduced ejection fraction (EF) and left atrial dilatation with cardioembolic stroke. Methods: Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016-2017 were included based on the following criteria: age >18 and availability of echocardiogram within 3 months of diagnosis. Stroke was subdivided into cardioembolic and non-cardioembolic based on MRI findings. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51%(male), 41-53% (female), moderately abnormal: 30-40% (same in both genders), and severely abnormal: <30% (same in both genders). Other variables included: left atrial volume size categorized into normal (≤34 ml/m 2 ) vs. enlarged (≥35 ml/m 2 ), gender, hypertension (SBP≥140 or DBP≥ 90), and known history of atrial fibrillation. Results: Two hundred eighteen patients were identified to have cardiomebmolic stroke and two hundred thirty-five with non-cardioembolic stroke. Among patients with cardiomebmolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged left atrium, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The number of patients with reduced EF and left atrial enlargement were significantly higher in patients with cardioembolic stroke (P<0.001). The odds of cardioembolic stroke were 2.0 and 8.8 times higher in patients with moderately and severely reduced EF, respectively, when compared to patients with normal EF. The odds of cardioembolic stroke was 2.4 times higher in patients with enlarged left atrial size when compared to patients with normal left atrial size. Conclusions: Our results have shown an independent association between moderately and severely reduced EF and enlarged left atrial size with cardioembolic stroke. Heart failure and left atrial dilatation may increase the risk of stroke regardless of the presence of atrial fibrillation, which warrants further studies to determine the appropriate treatment for secondary stroke prevention such as anticoagulation.

Successful Treatment of Lone Persistent Atrial Fibrillation by Means of a Hybrid Thoracoscopic-Transcatheter Approach

2012 ◽  
Vol 7 (4) ◽  
pp. 254-258 ◽  
Author(s):  
Claudio Muneretto ◽  
Gianluigi Bisleri ◽  
Luca Bontempi ◽  
Faisal H. Cheema ◽  
Antonio Curnis
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Hybrid Approach ◽  
Heart Rhythm ◽  
Persistent Atrial Fibrillation ◽  
Surgical Approaches ◽  
Surgical Ablation ◽  
Internally Cooled ◽  
The Mean

Objective Ablation strategies for the treatment of lone persistent atrial fibrillation (AF) have rapidly evolved during the past decade both with electrophysiological (EP) and surgical approaches. We investigated the safety and efficacy of a novel staged hybrid approach combining surgical thoracoscopic and EP ablation in patients with lone persistent AF. Methods Twenty-four consecutive patients with either persistent (three patients, 12.5%) or long-standing persistent (21 patients, 87.5%) isolated AF were prospectively enrolled: the mean age was 63.2 ± 9.3 years, the mean left atrial dimension was 50.5 ± 8 mm, and the mean AF duration was 82.7 months (range, 7–240 months). The surgical procedure consisted of a monolateral, right-sided, thoracoscopic closed-chest approach to perform a “box” lesion set with a temperature-controlled, internally cooled, radiofrequency monopolar device with suction adherence (Cobra Adhere XL; Estech, San Ramon, CA USA). A continuous monitoring rhythm device (Reveal XT; Medtronic, Minneapolis, MN USA) was implanted at the time of surgery in all patients for continuous long-term monitoring of the heart rhythm. Results Successful completion of the procedure was achieved in all cases, with a mean ablation time of 29 ± 9 minutes and an overall procedural time of 84 ± 16 minutes. After surgical ablation, the exit block was documented in all cases, whereas the entrance block was achieved in 87.5% (21 of 24 patients). No intensive care unit stay was required, and no complications occurred postoperatively; hospital mortality was 0%. At a mean interval of 33 ± 2 days after surgery, an EP study was performed: bidirectional block was confirmed in 79.1% (19 of 24 patients), whereas gaps at the level of the box lesion were observed in 20.8% of the patients (5 of 24 patients). Additional transcatheter endocardial right- and left-sided lesions were performed in 62.5% of cases (15 of 24 patients). At a mean follow-up of 28 months (range, 1–55 months), 87.5% of the patients (21 of 24 patients) are in sinus rhythm, and the incidence of left atrial flutter was 0%. Conclusions The combination of thoracoscopic box lesion and transcatheter ablation in a staged hybrid approach proved to be safe, providing excellent mid-term clinical outcomes in patients with long-standing, isolated, persistent AF. Moreover, the implantable loop recorders documented such incremental benefits in sinus rhythm restoration for up to 28 months.

scholarly journals Heart rate and outcome in heart failure with reduced ejection fraction: Differences between atrial fibrillation and sinus rhythm—A CIBIS II analysis

2017 ◽  
Vol 40 (9) ◽  
pp. 740-745 ◽  
Author(s):  
Bart A. Mulder ◽  
Kevin Damman ◽  
Dirk J. Van Veldhuisen ◽  
Isabelle C. Van Gelder ◽  
Michiel Rienstra
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Reduced Ejection Fraction
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